Structural and functional motor cortex asymmetry in unilateral lower limb amputation with phantom limb pain

Pacheco‐Barrios, Kevin; Pinto, CB B.; Velez, F G Saleh; Duarte, Dante; Gunduz, ME E.; Simis, Marcel; Gianlorenco, AC C. Lepesteur; Barouh, Judah L; Crandell, David; Guidetti, Matteo; Battistella, Linamara Rizzo; Fregni, Felipe

doi:10.1016/j.clinph.2020.06.024

Cited by 30 publications

(22 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The different contexts of evaluation brought by these two pain scales could explain the contradicting results in our model. Additionally, our finding regarding the VAS reinforces previous studies’ results, in which the same negative association between the ICF and VAS in patients with phantom limb pain was found 6 , 35 , 36 . All these finds may show that the VAS is not a good tool regarding cortex excitability.…”

Section: Discussionsupporting

confidence: 92%

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

View full text Add to dashboard Cite

This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (β: 0.01), WOMAC pain (β: 0.023), OA severity (as indexed by Kellgren–Lawrence Classification) (β: − 0.07), and anxiety (β: − 0.015). Similarly, CSP was associated with age (β: − 0.929), OA severity (β: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (β: − 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (β: − 0.094) and WOMAC (β: 0.062), and anxiety (β: − 0.039). Likewise, MT was associated with WOMAC (β: 1.029) and VAS (β: − 2.003) pain scales, anxiety (β: − 0.813), and age (β: − 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.

show abstract

Section: Discussionsupporting

confidence: 92%

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…A very recent study found an asymmetrical reorganization of the motor cortex in patients with phantom limb following a unilateral traumatic LLA, showing no association with pain intensity nor differences regarding the amputation side. [ 40 ] Our data however extend this concept to a general population with LLA, pointing out the need for further studies on the neurophysiologic possible changes related to the amputation side after the LLA.…”

Section: Discussionsupporting

confidence: 50%

Community ambulation in people with lower limb amputation

et al. 2021

View full text Add to dashboard Cite

Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited. To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA. An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome. The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = –0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4–6). These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.

show abstract

“…It was reported that the cortical motor map of 40.0% chronic low-back pain (CLBP) group subjects was leftward asymmetric compared with HC ( 16 ). Phantom limb pain ( 43 ) patient's motor cortex reorganizes asymmetrically, and the volume of gray matter in the affected hemisphere is reduced. Further studies are needed to investigated the whole motor cortex and reveal the neural asymmetry basis of the CSP or other chronic pain diseases.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the precentral gyrus, accumulating evidence has demonstrated that the motor cortical reorganization and asymmetries are associated with many chronic pain diseases (16,(41)(42)(43). It was reported that the cortical motor map of 40.0% chronic low-back pain (CLBP) group subjects was leftward asymmetric compared with HC (16).…”

Section: Surface Area Asymmetry Of the Precentral Gyrusmentioning

confidence: 99%

Structural and Functional Asymmetry in Precentral and Postcentral Gyrus in Patients With Unilateral Chronic Shoulder Pain

Wei

Shi

et al. 2022

Front. Neurol.

View full text Add to dashboard Cite

ObjectiveThe purpose of this study was to explore the structural and functional asymmetry of precentral and postcentral gyrus in patients with unilateral chronic shoulder pain (CSP) utilizing MRI.Patients and MethodsWe collected structural and resting-state functional MRI (rs-fMRI) data in 22 left-sided, 15 patients with right-sided CSP, and 24 healthy controls (HCs). Here, we performed the structural asymmetry and seed-based functional connectivity (FC) analyses. We extracted regional cortical thickness and surface area measurements from T1-weighted MRI images, using asymmetry indexes (AIs) to assess asymmetries. We used Data Processing and Analysis for Brain Imaging software for seed-based FC analysis and selected unilateral-precentral and postcentral as the regions of interest. Then, we performed group comparisons of the neuroimaging metrics, and also explored the relationships between brain asymmetry and clinical variables.ResultsWe found significant differences in surface area AIs of the precentral among three groups, the AI values were negatively correlated with the visual analog scale score and positively correlated with Constant–Murley scores (CMS) in the left-sided CSP group. Further, FC of left postcentral with cingulate gyrus and left paracentral lobule showed significant group differences; FC of right postcentral with left caudate, left paracentral, and left postcentral were different among groups; FC of right precentral with the cingulate gyrus, precuneus, and left paracentral revealed significant group differences. Besides, there was a positive correlation between right precentral-cingulate gyrus FC and CMS in the right-sided CSP group.ConclusionSurface area and FC patterns asymmetry exist in precentral and postcentral gyrus in patients with unilateral CSP. Asymmetry trend is associated with pain severity and shoulder joint function impairment. Brain structural and functional asymmetry may be an important indicator for understanding the potential mechanism of chronic pain.

show abstract

Structural and functional motor cortex asymmetry in unilateral lower limb amputation with phantom limb pain

Abstract: There is an asymmetrical reorganization of the motor cortex in patients with phantom limb pain. We found disorganized and shifted hand cortical representation in the affected hemisphere. This reorganization is not associated with pain intensity.

Cited by 30 publications

References 45 publications

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Community ambulation in people with lower limb amputation

Structural and Functional Asymmetry in Precentral and Postcentral Gyrus in Patients With Unilateral Chronic Shoulder Pain

Contact Info

Product

Resources

About